Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | G59862 | CA |
NPI | 1043436843 |
---|---|
Provider Name | Dr. William Clark Ardary |
First Address | Arcadia, CA 91007 |
Second Address | Arcadia, CA 91007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |